Silver HIT (Head Injury Trauma)

Factors influencing ambulance conveyance of older adults with minor head injury to the emergency department.

Study team

Study summary

The UK population is getting older. Head injuries result in 1.4 million emergency department attendances yearly in England and Wales. However, the mortality of minor head injury is very low and most patients recover without specific or specialist intervention. 

Reducing conveyance to hospital is already a priority of the NHS. However, COVID-19 has made the safe non-conveyance of older people with minor head injuries more pertinent than ever. Older adults are at greater risk of both hospitalisation and dying from COVID-19 and have been advised to limit their contact with others where possible. For this group of patients, hospital attendance increases the risk of coming into contact with the virus and it adds to the burden of an over-stretched hospital system.

Funded by the UWE Bristol Vice-Chancellor Early Careers Researcher Award, the ultimate aim of this study is to safely reduce hospital attendance for older people with minor head injury, thereby reducing costs to the NHS, improving patient satisfaction and reducing patients’ infection risk. This research addresses one of the top 15 NIHR research priorities for emergency medicine, ‘the prediction of which older patients attended by an ambulance crew can be safely and effectively managed at home’. 

This mixed methods study will include three stages of work.

  • Stage 1: A systematic literature review looking at what factors influence the conveyance of older people with minor head injuries by paramedics?
  • Stage 2: Retrospective data audit of routinely collected, anonymised ambulance service data to determine the scope and scale of conveyance of minor head injury in older adults by paramedics in the South West.
  • Stage 3: Semi-structured telephone interviews with approximately 12 paramedics within the South Western Ambulance Service NHS Foundation Trust (SWAST) to explore the decision making around conveyance of older people with minor head injury to hospital. The interviews will generate qualitative data that will be transcribed and analysed thematically.

The findings are expected to provide an understanding of the factors that influence paramedic decision-making around conveyance of older people with minor head injury. The ultimate aim being to safely reduce the conveyance of these patients to the emergency department.